London's Pulse: Medical Officer of Health reports 1848-1972

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London County Council 1934

[Report of the Medical Officer of Health for London County Council]

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Even if due allowance be made for the unfavourable age grouping in these series, the results
appear to be vastly inferior to those obtained in the "intravenous" or "intraperitoneal"
series. For example, the comparative figures for the important complication of acute suppurative
otitis media are :—

Primary suppurative otitis media in scarlet fever.

Series.Age group.
0—5 years.5—10 years.10—20 years.Over 20 year*.
Cases.Per cent.Cases.Per cent.Cases.Per cent.CasesPer cent.
Intravenous (1,010 cases)10411320.910.6
Intraperitoneal ( 193 „ )11.711.3
Intramuscular ( 86 „ )711.1210.5
No serum ( 275 „ )2016.544.011.9

In view of the fact that the "intramuscular" and "no-serum" groups consisted largely
of mild cases, the difference in the percentage incidence of otitis media under 5 years of age
between those and the " intravenous " and " intraperitoneal " groups becomes very striking.
It suggests that the incidence of otitis media at the younger ages may be very considerably
reduced by the use of intravenous or intraperitoneal serum in treatment.
On a review of the year's work in scarlet fever it may be fairly claimed that the results of
routine intravenous serum treatment continue to be unsurpassed and that a promising vista
has been opened in regard to the use of the intraperitoneal method.
Three deaths from scarlet fever occurred at the South-Eastern hospital during
1934, and the medical superintendent (Dr. Ronaldson) has submitted the following
particulars with regard to them :—
(1) Female, aged 11 years. Scarlet fever complicated bv streptococcal peritonitis.
Transferred from another hospital for immediate operation. Patient only survived for a
few hours after operation. No serum had been given.
(2) Male, aged 4 years. Admitted in a post-eruptive stage with pyaemia and suppurative
arthritis. Serum given.
(3) Female, aged 4 years. Admitted with moderate attack of scarlet fever. Serum
given. Subsequently discovered to have been exposed to measles before admission;
developed measles on the sixth day in hospital. Cause of death, bronchopneumonia.
Dr. Ronaldson adds that, while the almost nominal mortalities from scarlet
fever at the South-Eastern hospital during the past four years, viz., -2 per cent, in
1931, -3 per cent, in 1932, and -2 per cent, in 1933 and in 1934 are an index of the
comparatively mild nature of the prevailing type of the disease and very low figures
were recorded by all the London infectious hospitals, the gratifyingly low figure
for the South-Eastern hospital for the four-year period suggests that the intensive
serum therapy employed has materially contributed to the result. He expresses the
opinion that the low incidence of complications, including an almost complete disappearance
of acute nephritis, and a low return case rate, are even more significant.
A detailed account of the work done is being prepared for publication.
Two of the cases under treatment during the year at the South-Eastern hospital
were examples of toxic scarlet fever. The medical superintendent reports that one
of them had an unusual complication, viz., a toxic auricular fibrillation, which cleared
up completely after serum treatment. Another unusual manifestation in this case
was the recovery of anaerobic streptococci from the blood. The organisms present in
the throat were aerobic hemolytic streptococci (type ii). Both cases recovered.
The medical superintendent of the Grove hospital (Dr. J. H. Whitaker) has reported
that six deaths were attributed to scarlet fever at that hospital during the